The police, the prosecutor's office, and the judges are irrevocably on the side of the doctors. The patient was even denied a handwriting examination.
The Russian law "On psychiatric care and guarantees of citizens' rights during its provision" No. 3185-1 protects not only mentally healthy people from compulsory psychiatric treatment, but also patients with a previously established psychiatric disorder. It is possible to forcibly place a person in a hospital for the provision of psychiatric care only by a court decision, or with the patient's informed voluntary consent to medical intervention.
40-year-old Sergey Abramov from Norilsk, who has contacted the editorial office of NI, is making a serious accusation against the doctors of the Krasnoyarsk Regional Psychoneurological Dispensary No. 5: his written consent has been falsified.
At the same time, our interlocutor does not hide the fact that the diagnosis from the so-called. "Small psychiatry" he was given in his youth. The medical commission of the military registration and enlistment office revealed that he had a "transient personality disorder", which became the basis for exemption from military conscription. Marked as "limited fit", the young man was added to the reserve.
This disorder, however, does not belong to serious diseases, occurs in a limited period of time, most often in youth, in most cases the pathology is curable, and the diagnosis can be withdrawn after a while.
After the military commissariat medical commission, Sergey was not sent for treatment, he was not put on a psychiatric record, and he was not prescribed special drugs, he says.
The turning point was August 2011. Then the 30-year-old man lived with his parents in their apartment. According to the stories of Sergey himself, the conflict arose due to disagreements over appearance and clothing. Parents insisted that the son wear things that mom and dad liked. In response to this demand, Sergey tore open his jacket, which he had not liked for a long time.
Further events developed rapidly. Here is the version of Sergey himself.
“In the morning I had a fight with my father. And after 14-16 hours, closer to the night, the police came for me and demanded to follow them. They brought me to Bohdan Khmelnitsky, 16 - a neuropsychiatric dispensary is located at this address in Norilsk. When asked why I should stay here, I was told that a certain doctor, later it turned out that it was the head of the Avanes men's department, with a quick glance, in a couple of seconds diagnosed me. He did it from afar, the doctor did not even approach me, did not speak. After I was seized and tied up by people in white coats, they stabbed me with something and I fell into an unconscious state”, - the source said.
Over the next month, Sergey Abramov spent in a psychiatric hospital, where he had to take psychotropic drugs - the orderlies asked him to open his mouth to make sure he was taking medication.
“The hospital staff tried to convince me that I was allegedly sent for compulsory treatment by the police, but I never saw any documents about this. The same Aram Avanesov, who at that time was the head of the department where I was, could not clearly explain what I was being treated for, why, who, when and how diagnosed and what it was called, could not, arguing that it was prohibited by some rules ” ...
The law directly provides for close communication between the doctor and the patient who has agreed to be treated voluntarily:
“The doctor is obliged to provide the person suffering from a mental disorder, in an accessible form for him and taking into account his mental state, information about the nature of the mental disorder, goals, methods, including alternative ones, and the duration of the recommended treatment, as well as about pain, possible risks, side effects and expected results. An entry is made about the information provided in the medical documentation”, - follows from Art. 11 FZ 3185-1.
On discharge, Sergey was asked to come to the polyclinic once a month for two years, where they were supposed to monitor his condition and issue prescriptions for subsidized (free) drugs.
“For these prescriptions, I received medicines at the pharmacy without paying. Among them were, including drugs included in the list of potent drugs. Why I needed these drugs, no one explained either. The doctors assured me that they were needed to recover from a disease, the name of which was never given to me. The doctor's observations were also carried out in a strange way - despite the wording in the medical record about examinations, in fact, examinations were not carried out, they did not really talk to me, just from visit to visit the old diagnosis was rewritten. During the same period, nurses came to their home address and asked to take medications, but they did not answer the questions - what they were treating me for, why should I take these medications”.
However, any medical observation from Sergey was removed after his complaints to the prosecutor's office, and since then, as he himself says, no one has ever been interested in his mental health.
“After the hospital, of course, I quickly found out that the police did not have the authority to send for compulsory psychiatric treatment, and this can only be done through the courts. Forced confinement in a psychiatric hospital and the obligation to take psychotropic drugs without a court decision is a criminal offense. I wrote complaints to the prosecutor's office and the health department. But from there unexpected answers came to me: it turns out that I myself voluntarily went to a psychiatric hospital and signed all consents to this”, - says Sergey.
After consulting with lawyers, the man asked the KGBUZ "Krasnoyarsk Regional Psychoneurological Dispensary No. 5" copies of his medical records, from which he finally learned his diagnosis: schizotypal disorder. But the real discovery for Sergey was two sheets attached to the medical card: about voluntary consent to hospitalization and treatment: “The handwriting is not mine, the signatures are not mine”, - he says.
Then Sergey filed an application with law enforcement agencies to bring officials of the medical institution to criminal responsibility (Article 129 of the Criminal Code of the Russian Federation Illegal hospitalization in a medical organization that provides psychiatric care in inpatient conditions).
The police interviewed the father and the doctor who made the decision on hospitalization, and came to the conclusion that there was no criminal component in these events:
“At first, they refused to initiate a case, based on the testimony of the head Avanesov: according to him, I went to undergo treatment voluntarily, no one allegedly tied me up, didn’t chuck me to an unconscious state - he thinks that all this was in my dreams, all these are my hallucinations”, - says Sergey.
According to the man, he was repeatedly refused to carry out a handwriting examination: first, due to the fact that the copies of documents for research are in poor quality (and they are sent for research by investigators), then due to an insufficient number of handwriting samples, and, finally, due to for the fact that fresh samples of handwriting cannot be subject to examination, since many years have passed since 2011, and the handwriting could have changed.
Sergey Abramov was also refused to initiate a criminal case on falsification of voluntary consent. Then he appealed against this refusal in court. But nothing was achieved through the court.
In court, the prosecutor and the deputy head of the investigative body petitioned to terminate the proceedings on the complaint of Abramov, since at the time of its consideration the investigator's decision to refuse to initiate a criminal case was canceled.
The Norilsk City Court thus stopped the process due to the missing subject of the trial.
But, despite the alleged desire of the investigation to take up the case of Abramov, he was not given a move. The former patient called the Investigative Committee for several months, at first he was fed "breakfasts", and the investigators did not answer the last calls at all. After a couple of years, Sergey abandoned the idea of punishing the employees of the mental hospital. By that time, his main counterpart - the Norilsk psychiatrist Aram Avanesov had already come under criminal prosecution - he was suspected of repeated theft of patients' funds from bank accounts. The police detained the head of the men's department of the Norilsk neuropsychiatric dispensary # 5 a year after the incident with Sergey Abramov. In July 2017, he was found guilty of abuse of office, theft and fraud and sentenced to 5 years in prison for stealing more than 3 million rubles from the accounts of 11 patients.
“The crimes were committed between 2009 and 2012. The doctor instructed his subordinates to take patients out of the hospital to the Sberbank department and withdraw money from their personal accounts. All money was transferred to him. Then he instructed to issue bank cards for transferring pensions to patients and thus received unhindered access to pin codes. The city court sentenced the doctor to 5 years in a general regime colony. The money was never returned to the patients”, - the press service of the Krasnoyarsk Territory Prosecutor's Office reported.
Sergey Abramov is still listed as a patient of psychiatric services with all the ensuing restrictions.
“For example, I cannot get a driver's license or a license for hunting weapons, I am restricted in a number of professions, and so on”, - he says.
According to him, the parents left Norilsk after working until retirement. He stayed alone in the apartment. Lives on income from his individual entrepreneur - is engaged in advertising on the Internet. He didn't start his own family.
In 2020, having learned about the imminent expiration of the statute of limitations for bringing to justice the doctors who forcibly hospitalized him, Sergey decided to revive his business and try to challenge the established psychiatric diagnosis.
"Any court sees a psychiatric illness on medical documents. It is possible to prove falsification of medical documentation, to challenge the diagnosis with the help of an independent examination. A person conducts a handwriting examination, establishes that it was not he who signed the consent, the question arises - where does the card come from and why is it inserted, and so on. As far as I understand, this was not done for some reason. The fact that after some time the doctors and nurses, as he says, ceased to be interested in the patient's health, indicates that the account in relation to him was weakened, and the patient was transferred from the dispensary observation group to the advisory observation group", - the lawyer comments Nelly Gusarova.
Unfortunately, it is not uncommon for a patient's voluntary consent to compulsory psychiatric treatment to be faked within the walls of medical facilities. By the letter of the law, this is definitely a crime. Another thing is that it is almost impossible to prove falsification. The law enforcement and judicial system in Russia in 99.9% takes the side of the psychiatrist, who petitions for the temporary isolation of a person from society. Psychiatrists in our country still consider the liberalization of the legislation on psychiatry to be a wrong step, and continue to work on the quiet according to Soviet standards.
In today's legislation, there are gaps and conflicts regarding severe conditions. What should doctors do if a patient presents with acute psychosis? He urgently needs to be removed, you can't wait, in this state you can kill yourself or those around you. In the conflict between the interests of society and the rights of the individual, the collective wins so far: it is better to keep an eye out so that the patient does not decide on anyone, than to think about the interests of the individual - an infinitely subtle and debatable matter...
"Violation of the law (falsification of medical records) cannot be justified by anything. Even if a person really needs urgent psychiatric help, today there are absolutely legal grounds to keep him in a medical facility for up to 3 days. Doctors have this time to collect and submit documents to the court, while the court itself can be mobile and take place within the walls of a psychiatric hospital. If, in the case of Sergey Abramov, the psychiatrists and the council were so sure that the person needed help, but he didn’t agree, why didn’t they go to court? This procedure does not cause protest either from society or from the patient himself, ”says psychiatrist and human rights activist Sofya Dorinskaya. - It's another matter that, of course, we still do not have the resources, the hospitals do not have the capacity to keep such people in special conditions. All these 3 days, and then even up to 5 days that the court has to set the date of the meeting, a person can be within the walls of the hospital. But doctors still do not have the right to prick him, apply medication, and it is necessary to organize the maintenance of a person in special wards, where he cannot harm himself. We see such conditions so far only in foreign films: rooms without corners, upholstered on all walls, floor and ceiling with soft materials".
Disputes about the humanity of Russian psychiatry have been going on for a quarter of a century, since psychiatric registration was abolished in the country.
In 2015, the deputy chairman of the Duma Committee on Constitutional Legislation and State Building Vadim Soloviyev, referring to recent examples of murders committed by mentally ill people, took the initiative to return to the Soviet practice of treating people with psychiatric diagnoses. He proposed to forcibly hospitalize people with mental disorders at the request of relatives, acquaintances, neighbors, or just passers-by, as well as create a single database of such patients so that they are always under supervision.
According to the deputy, the current legislation does not provide for any preventive measures in relation to the mentally ill. If a person does not rage, does not show signs of mental illness in the presence of doctors and government officials, while at the same time he is atrocities at home, there is still no reason to even send him for a medical examination.
The problem is not that people suffer from psychoses, but that the current system of psychiatry cannot provide them with effective medical care. Neuroses and psychosis, like kidney and liver diseases, are simply diseases. Inability, ignorance, unwillingness to deal with the causes of health disorders in patients, a built industry where a complete examination of the patient is impossible - this is the root of the problem of insoluble, untreated psychoses and the ineffectiveness of psychiatry as a field of medicine. What does the current Russian psychiatry offer its patients, how does it “save” society from madness? Pumps people with legal drugs. The UN Office on Drugs claims that drugs in 100% of cases turn people into asocial elements - into madmen, criminals, murderers and suicides. All categories of permitted psychoactive substances today are, in fact, synthetic drugs, and their difference from illegal drugs is only that they are prescribed by a doctor. Do drugs treat people? No, they only aggravate their problems, - human rights activists answered then to the deputy.
They also reminded the parliamentarian of the risks of the revival of punitive psychiatry, which they often faced in the 60-80s of the last century in the Soviet Union.
Abstract preventive measures are more likely to harm people susceptible to mental illness than help them. Instead, we need to engage in large-scale prevention of mental illness in the population - the development of outpatient mental health services. And it is practically eliminated after the well-known optimization of medicine, they say in the medical community.
According to the latest WHO data, in Russia the number of patients in need of psychiatric or psychological assistance is about 14 million people (10% of the population). According to 2015 data, about 8 million people apply for psychiatric care in the country every year, of which about 5 million become permanent patients of psychiatrists. At the same time, according to official medical statistics, out of all recorded only 15 thousand patients pose a real threat to society - that is, they are capable of a crime in a state of exacerbation.
So is it humane because of 15 thousand people (potential criminals) to legalize compulsory treatment and isolation for every tenth Russian?
"There is a catastrophic lack of an independent observer in the current psychiatric system in Russia. Why, when we talk about an alleged criminal, does society stand guard over his rights with all its might? He is provided with a lawyer, he himself is an equal participant in the process, his arguments are assessed on a par with the arguments of the investigation, during interrogations the alleged criminal writes: “it was written down correctly from my words,” or he may not agree with what was written. He has the benefit of the doubt. The judge releases even a real murderer and rapist if the investigation does not have enough evidence. Placement in a psychiatric dispensary is also imprisonment. But why, when it comes to the mentally ill, is a person in this system automatically excluded from the equal participants in the process from the very first minute? Even if we are talking about patients in serious condition, with acute psychoses, when he himself cannot sign or confirm anything, we still face a big problem: evidence from the second side", - says Sofya Dorinskaya.
No evidence has been collected - there is not even a chance to prove your case later. Once in the psychiatrist's office, the patient is left alone with him, and everything that the doctor writes will be a priori correct, and what the patient says is not. The prosecutor, the judge only deal with the doctor's evidence and take it on faith. This flaw, a legal failure, when a person cannot say anything in court against the words of a psychiatrist, must be removed. All conversations with a psychiatrist should be recorded on video. At each meeting with a psychiatrist, an advocate, an independent observer, who will simply defend his rights, should sit next to the patient. What, there are few cases in Moscow and in Russia when fraudsters with the help of a compliant psychiatrist took away property, real estate, money from the mentally ill? Who said that psychiatrists cannot be engaged? Abuse is rife in any closed area, and psychiatry belongs to that area, the expert says.
Closing and forgetting a person, following only public fears, is a dangerous tendency. Society is always fearful. In the Middle Ages, it was afraid of witches, and we all know how it ended. Now society is afraid of the mad. But even about recidivist criminals, the police say: "When they kill you - come". Why is there a different attitude towards the mentally ill? Are psychiatrists so far-sighted - they predict crimes with accuracy? Not.
According to the modern classification of mental illness, a psychiatric diagnosis can be made to anyone. Free, as they say, are only those who, for some mysterious reason, have not yet come under the watchful eye of people in white coats. If we want to live in a society that is sensible to the deprivation of a person's freedom, then all blind spots from the legislation on psychiatry must be removed, otherwise we all risk falling into this blind spot, Dorinskaya sums up.